- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $549.54 / $891.25
| Facility | | $34.67 | $549.54 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,096.48 / $1,096.48 / $1,096.48
| Facility | 50 | $1,096.48 | $1,096.48 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $45.71 / $123.03
| Professional | | $30.20 | $45.71 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.62 / $64.57 / $134.90
| Professional | | $31.62 | $64.57 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.74 / $75.86 / $186.21
| Professional | | $40.74 | $75.86 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.88 / $95.50 / $213.80
| Professional | | $33.88 | $95.50 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $380.19 / $691.83
| Facility | | $34.67 | $380.19 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,096.48 / $1,096.48 / $1,096.48
| Facility | 50 | $1,096.48 | $1,096.48 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.88 / $70.79 / $162.18
| Professional | | $33.88 | $70.79 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.67 / $70.79 / $177.83
| Professional | | $34.67 | $70.79 | $177.83 |